Vicksburg Clinic Llc - Medicare Primary Care in Vicksburg, MS

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Vicksburg Clinic Llc is a medicare enrolled primary clinic (Family Medicine) in Vicksburg, Mississippi. The current practice location for Vicksburg Clinic Llc is 2100 Highway 61 N, Vicksburg, Mississippi. For appointments, you can reach them via phone at (601) 883-5000. The mailing address for Vicksburg Clinic Llc is Po Box 689022, Franklin, Tennessee and phone number is () -.

Vicksburg Clinic Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1790711158. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (601) 883-5000.

Contact Information

Vicksburg Clinic Llc
2100 Highway 61 N
Vicksburg
MS 39183-8211
(601) 883-5000
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameVicksburg Clinic Llc
SpecialityFamily Medicine
Location2100 Highway 61 N, Vicksburg, Mississippi
Authorized Official Name and PositionKristina Music (DIRECTOR PROVIDER ENROLLMENT)
Authorized Official Contact6154657000
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Vicksburg Clinic Llc
Po Box 689022
Franklin
TN 37068-9022

Ph: () -		Vicksburg Clinic Llc
2100 Highway 61 N
Vicksburg
MS 39183-8211

Ph: (601) 883-5000

NPI Details:

NPI Number1790711158
Provider Enumeration Date06/25/2006
Last Update Date11/20/2024

Medicare PECOS Information:

Medicare PECOS PAC ID5890696330
Medicare Enrollment IDO20040116000738

Medical Identifiers

Medical identifiers for Vicksburg Clinic Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1790711158NPI-NPPES
200002582MedicaidMS
1444596MedicaidLA
1446084MedicaidLA

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine (* (Not Available))Primary
2085R0001XRadiology - Radiation Oncology (* (Not Available))Secondary
208D00000XGeneral Practice (* (Not Available))Secondary
363LF0000XNurse Practitioner - Family (* (Not Available))Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Vicksburg Clinic Llc acts as a billing entity for following providers:
Provider NameGeri L Weiland
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1700821931
PECOS PAC ID: 6204875404
Enrollment ID: I20050427000760
Provider NamePaul W Pierce
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1821005265
PECOS PAC ID: 9335181379
Enrollment ID: I20050531000749
Provider NameCraig A Cole
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1659460384
PECOS PAC ID: 2668417437
Enrollment ID: I20050622000662
Provider NameFeras Hamadeh
Provider TypePractitioner - Pulmonary Disease
Provider IdentifiersNPI Number: 1518051705
PECOS PAC ID: 4284542176
Enrollment ID: I20080602000369
Provider NameEugene B Ferris
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1235168626
PECOS PAC ID: 5597838185
Enrollment ID: I20080715000445
Provider NameTimothy P Kerut
Provider TypePractitioner - Allergy/immunology
Provider IdentifiersNPI Number: 1932130127
PECOS PAC ID: 6002980752
Enrollment ID: I20080730000192
Provider NameGloria J Butler
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1750312963
PECOS PAC ID: 3971665589
Enrollment ID: I20081216000305
Provider NameWilliam Porter
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1528099413
PECOS PAC ID: 5698838423
Enrollment ID: I20090106000188
Provider NameWalter E Johnston
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1952332181
PECOS PAC ID: 1355407776
Enrollment ID: I20090309000575
Provider NameJohn D Fagan
Provider TypePractitioner - Urology
Provider IdentifiersNPI Number: 1801827019
PECOS PAC ID: 7012067010
Enrollment ID: I20090612000518
Provider NameMurray P Whitaker
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1053349373
PECOS PAC ID: 2264586759
Enrollment ID: I20090818000639
Provider NameStanley R Easterling
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1154359818
PECOS PAC ID: 1254464209
Enrollment ID: I20100728000749
Provider NameThomas K Sligh
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1811928005
PECOS PAC ID: 0143353003
Enrollment ID: I20100729000743
Provider NameGordon W Sluis
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1831127422
PECOS PAC ID: 9335272194
Enrollment ID: I20100729000860
Provider NameLisa D Fairchild
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1033154794
PECOS PAC ID: 7618000407
Enrollment ID: I20100730000254
Provider NameThomas C Moore
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1184655060
PECOS PAC ID: 1355474164
Enrollment ID: I20100730000519
Provider NameErin S Bennett
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1144547555
PECOS PAC ID: 3971636788
Enrollment ID: I20100730000549
Provider NameDeborah Smith
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1841228087
PECOS PAC ID: 7719010537
Enrollment ID: I20100730000644
Provider NameThomas L Weeks
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1760427090
PECOS PAC ID: 6507999265
Enrollment ID: I20100802000202
Provider NameSidney A Johnson
Provider TypePractitioner - Radiation Oncology
Provider IdentifiersNPI Number: 1497757603
PECOS PAC ID: 8022142405
Enrollment ID: I20100820000514
Provider NameSteven Zachow
Provider TypePractitioner - Radiation Oncology
Provider IdentifiersNPI Number: 1518969724
PECOS PAC ID: 6103908850
Enrollment ID: I20110126000720
Provider NameElizabeth L Herrington
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1306043278
PECOS PAC ID: 4284814567
Enrollment ID: I20110203000199
Provider NameGwendolyn J Stewart
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1043442254
PECOS PAC ID: 7113108945
Enrollment ID: I20110225000721
Provider NameSarah E Williams
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1598097883
PECOS PAC ID: 2567639206
Enrollment ID: I20120119000863
Provider NameIzzeddin Kamelmaz
Provider TypePractitioner - Pediatric Medicine
Provider IdentifiersNPI Number: 1346344421
PECOS PAC ID: 9436119179
Enrollment ID: I20120202000515
Provider NameKenyatta N Wilson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1457633034
PECOS PAC ID: 5799943106
Enrollment ID: I20120214000728
Provider NameMarie E Allen
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1174803829
PECOS PAC ID: 4587826821
Enrollment ID: I20120502000201
Provider NameAmy C Campbell
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1770876377
PECOS PAC ID: 9537323340
Enrollment ID: I20120607000111
Provider NameMiranda R Mccaskill
Provider TypePractitioner - Qualified Audiologist
Provider IdentifiersNPI Number: 1821431990
PECOS PAC ID: 4284872763
Enrollment ID: I20130522000295
Provider NameTimothy Trotter
Provider TypePractitioner - Thoracic Surgery
Provider IdentifiersNPI Number: 1285602532
PECOS PAC ID: 5395751663
Enrollment ID: I20130523000018
Provider NameFidel Fabian Sendra
Provider TypePractitioner - Thoracic Surgery
Provider IdentifiersNPI Number: 1265521710
PECOS PAC ID: 9739155946
Enrollment ID: I20130719000104
Provider NameTulio Figarola
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1457357691
PECOS PAC ID: 8224934393
Enrollment ID: I20140124000431
Provider NameChasity L Torrence
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1407110554
PECOS PAC ID: 2365665395
Enrollment ID: I20140521000102
Provider NameHolly M Kinget
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1336376953
PECOS PAC ID: 6901026889
Enrollment ID: I20140926001175
Provider NameAlan Jeffrey Torrey
Provider TypePractitioner - Anesthesiology
Provider IdentifiersNPI Number: 1750693206
PECOS PAC ID: 7719299288
Enrollment ID: I20150713000735
Provider NameChristopher Hope
Provider TypePractitioner - Psychiatry
Provider IdentifiersNPI Number: 1275829319
PECOS PAC ID: 3870809080
Enrollment ID: I20151007001357
Provider NameKimberly Renee Kilpatrick
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1881146306
PECOS PAC ID: 0446537617
Enrollment ID: I20170426001990
Provider NameAdam Nicholas Protos
Provider TypePractitioner - Cardiac Surgery
Provider IdentifiersNPI Number: 1629383922
PECOS PAC ID: 8325277007
Enrollment ID: I20170802001574
Provider NameChristopher Eugene Clark
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1962704999
PECOS PAC ID: 1052582939
Enrollment ID: I20171025000616
Provider NameKerrie Kashaun Sanders
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1144695669
PECOS PAC ID: 9537425921
Enrollment ID: I20171120000305
Provider NameDeclan F Hegarty
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1477526945
PECOS PAC ID: 5698774719
Enrollment ID: I20180102001542
Provider NameArie Ceville Shaw
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1821355421
PECOS PAC ID: 0042456501
Enrollment ID: I20180328002860
Provider NameJoyce Wanjugu Muruthi
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1255777025
PECOS PAC ID: 6709140098
Enrollment ID: I20180515001023
Provider NameAllen B Yelverton
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1710472790
PECOS PAC ID: 0345590048
Enrollment ID: I20180829004477
Provider NameBrandon L Mizell
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1649624693
PECOS PAC ID: 9739468562
Enrollment ID: I20190911001720
Provider NameKaran Puri
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1164945812
PECOS PAC ID: 3274946876
Enrollment ID: I20201228000958
Provider NameMatthew Knight
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1326139601
PECOS PAC ID: 7517130974
Enrollment ID: I20210105002006
Provider NameJoshua Holifield
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1194174755
PECOS PAC ID: 5395039325
Enrollment ID: I20210623000079
Provider NameChristopher Tipton
Provider TypePractitioner - Orthopedic Surgery
Provider IdentifiersNPI Number: 1801282223
PECOS PAC ID: 2466763156
Enrollment ID: I20210628000074
Provider NameJames Stanford
Provider TypePractitioner - Otolaryngology
Provider IdentifiersNPI Number: 1063866705
PECOS PAC ID: 9133412976
Enrollment ID: I20210713003784
Provider NameCandace Houston
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1558955344
PECOS PAC ID: 1850783648
Enrollment ID: I20220128001725
Provider NameShelby Patricia Primeaux
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1942870910
PECOS PAC ID: 9537554860
Enrollment ID: I20220323000079
Provider NameNiyazi Kilic
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1972096113
PECOS PAC ID: 1951783802
Enrollment ID: I20220809002256
Provider NameKimberly Marie Zachow
Provider TypePractitioner - Obstetrics/gynecology
Provider IdentifiersNPI Number: 1669960290
PECOS PAC ID: 4385020247
Enrollment ID: I20220929001331
Provider NameRamon Caballero
Provider TypePractitioner - Urology
Provider IdentifiersNPI Number: 1851480453
PECOS PAC ID: 6901798263
Enrollment ID: I20230523000032
Provider NameClyde Neal Ellis
Provider TypePractitioner - General Surgery
Provider IdentifiersNPI Number: 1093762908
PECOS PAC ID: 4082699376
Enrollment ID: I20231130002605
Provider NameSalena Cecil
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1992122394
PECOS PAC ID: 1456579523
Enrollment ID: I20240517003477
Provider NameAshley Turner Riggs
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1760296966
PECOS PAC ID: 1254851678
Enrollment ID: I20250227003455

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.